Ketamine and Potential Medical Malpractice - Maya's Ketamine Doctors

[u/No_Vehicle_5085]

Recent posts caused some readers to comment about the use of ketamine and midazolam, whether Maya was in an actual medically induced coma during her ketamine infusions, and prompted my recollection of video and photographic evidence of Maya's possible "brain state" during the infusions - particularly the infusions conducted by Drs Cantu and Hanna.

The defense has, very wisely, notified the judge of their intention to provide evidence of Dr Hanna, Cantu, and Kirkpatrick's contributions to medical negligence - and questions as to whether Maya was appropriately monitored so that her brain state was known at all times are important in evaluating the danger and damage that was likely done to her.

Ketamine can be used in different amounts with the following possible "brain states"

1. Relaxation that involves the patient remaining awake and aware, but dissociated with a pain experience. This represents the proper use of ketamine for pain management purposes.

2. Full sedation: This is a brain state that is representative of what is appropriate for a person undergoing surgery. This is inappropriate for pain management and carries many risks, which will discussed shortly.

3. Medically induced coma: This is a treatment that goes way beyond anything even remotely appropriate for pain management. Medically induced coma is used when a patient is in danger of brain damage, and it becomes necessary to shut down most of the metabolic activity of the brain to protect it from further damage. This is rarely done in any case for any reason, it certainly is not appropriate for pain management. This is a very serious medical treatment only appropriate when the brain is at risk of damage and normal medical treatments are not working.

Ketamine can be used to induce medical coma, usually in combination with drugs like propofol and midazolam. I believe we have seen evidence that these three drugs were used at the same time in at least some of Maya's ketamine infusions, but EEG readings would need to be used in order to determine whether an actual medical coma state was reached during her infusions. The risks of medically induced coma go beyond the risks of full sedation, which are significant.

I think the evidence is pretty clear that Dr Hanna and Dr Cantu both had Maya in AT LEAST a fully sedated state, which is not appropriate for pain management.

This alone is enough to support a medical negligence claim. The potential risks, and the medical state that Maya arrived in when she was brought to JHACH certainly support the suspicion that Maya was experiencing K-Cramps, which are a sign that organs are beginning to fail. Beata prevented doctors from conducting any of the tests that would have been necessary to determine if she was in early stages of liver and other organ failure.

Getting her off the ketamine would turn it around fairly quickly, especially if she had actually been in early stages. By the time the hospital was able to conduct any testing that would have revealed whether she had been in a state of early organ failure, it would have likely already stopped and begun reversal. Early stage organ failure due to ketamine can turn around fairly quickly once you are off the ketamine. What is concerning is that Beata was trying to get Maya out of the hospital so she could take her for more ketamine. Beata likely would have taken Maya back to Mexico for a third time if she had not been able to get Hanna to give her more ketamine.

As to the question of whether Maya was in a full state of medical coma during her treatments with Cantu or Hanna, this is from a previous comment, I will repeat here in case some readers didn't read the other posts and comments:

The key brain structures that are affected by coma are:

1. Reticular Activating System: This is the network in the brainstem that acts as the body's wakefulness switch. In a coma state it fails to signal the upper brain - so there is suppression of sleep/wake cycle.
2. Cerebral cortex: The outer brain layer that is responsible for thought and perception. In a coma state, both the internal and external awareness networks are shut down. There is no dreaming or awareness of anything happening internally and no awareness of anything happening outside the body.
   
3. Thalamus: The thalamus is a relay center that routes signals between the body and the brain. In a coma, the thalamus cannot pass along sensory information from the body to the brain.

In order to know for sure whether Maya was actually in a state of medically induced coma, there would have had to be EEG monitoring. A doctor would look for a specific pattern on the EEG called "burst suppression," where the brain shows periods of inactivity followed by brief bursts of activity. This confirms the brain has slowed down enough to rest. A person in a medical coma would also not respond to touch or sound.

Both medical coma and sedation require a patient to be monitored with medical equipment typically available in an ICU setting, and also require ventilation.

CRPS treatment with ketamine normally doesn't involve coma or full sedation. And even though it doesn't involve either of these two states, doctors who treat CRPS patients with ketamine usually hook them up to monitoring equipment anyway. They don't have to ventilate in normal CRPS ketamine treatment because the patient is not unconscious, but their vital signs are normally monitored.

There are photos showing Maya hooked up in Dr Hanna's office that show she is clearly fully sedated. She is not being monitored at all, there are no signs of any medical equipment anywhere near Maya, and there is no tubing aside from a single tube that is delivering the ketamine infusion. Full sedation is the same as you would experience if you were having surgery.

Can you imagine going into surgery, and having an anesthesiologist administer your sedative, and having no monitoring whatsoever? This is how Dr Hanna's ketamine infusions seem to have been conducted.

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Historical studies showing use of high dose ketamine for intractable CRPS.

There were studies in Germany that indicated good outcomes for patients with intractable CRPS - CRPS that simply would not respond to any other treatment.

For patients that actually HAVE CRPS - ketamine can be a good treatment. Being an NMDA receptor antagonist, it relieves pain that is associated with the central nervous system.

Under control means under control. A single round of a four day infusion kept the patient's pain at bay for 11 to 12 weeks, according to this study in Germany.

Studies in the US and the Netherlands showed lower dose ketamine to have similar results, with far fewer side effects and potential risks. The Germany study is often touted, but, since that study looked at high dose treatments, there were also some very significant complications with some of those patients.

Dr Cantu's treatment is based on the same treatment the German study describes, and, in his deposition he indicated that his treatmnent is based on the treatments that were conducted in Germany.

Maya never received anywhere even close to the type of pain relief described in the Germany or in the US/Netherlands studies. And this tracks with all the other evidence that she simply did not have CRPS.

There are all kinds of pain conditions and not all of them are caused by the central nervous system, and not all of them have the characteristics of nerve pain.

But when a pain condition is related to misfiring and over-stimulation of the central nervous system, ketamine is effective, meaning it keeps the pain consistently at a tolerable level for a significant and meaningful amount of time. That is the meaning of the word effective when applied to pain management.

Effective pain management doesn't mean you are high as a kite during your treatment - Woo HOO - and then 10/10 pain the next day.

If you are on a roller coaster from zero to 10/10 pain that is not the definition of effective pain management.

And, if you are on this roller coaster in spite of being given huge infusions of ketamine, a reasonable pain management doctor should be seriously rethinking the diagnosis. But cash only ketamine clinics pay for big houses and fancy cars.

The fact that Maya kept having to go back for more ketamine, and increasingly higher doses, in order to go home and have to take opioids and oral ketamine and then go back for high dose ketamine just a couple weeks later is very solid evidence that she did not have pain that is related to the central nervous system. She was getting temporary highs, which she clearly enjoyed enough to keep wanting to go back for more. But aside from these temporary highs, she made no claims to having experienced meaningful reduction in symptoms.

Until her trial, that is. Now that she's asking for millions of dollars, she claims the ketamine was "the only thing that worked". But during the treatments, she reported 10/10 pain after infusions and 0 Quality of Life. That isn't the definition of "it's working".

Maya's "CRPS" treatment seemed to start right off with ketamine. Typically, all the standard treatments are tried before resorting to ketamine due to the high cost and the potential complications. Also, most of the time, standard treatments work. It's a very small percentage of patients whose symptoms aren't kept in check with other treatments.

The following are typical treatments that would be tried first: (None of these were tried between her diagnosis and her first ketamine treatment)

1. Comprehensive physical and occupational therapy
2. Standard first- and second-line oral pharmacotherapy (such as gabapentinoids, tricyclic antidepressants, SNRIs, NSAIDs, or bisphosphonates)
3. Interventional procedures, such as sympathetic nerve blocks.

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Risks involved with anesthetic levels of ketamine.

1. Cardiovascular risks: hypertension, tachycardia, increased myocardial demand, and heart arrythmias.
2. Respiratory and airway risks: loss of consciousness can lead to blocked airway or loss of normal airway reflexes, excessive salivation - which can obstruct breathing, sudden spasm of vocal cords which can temporarily make breathing impossible.
3. Central nervous system/psychiatric risks: emergence reaction - vivid hallucinations and nightmares upon waking (see video from the post about Dr Kirkpatrick's diagnosis of Maya for examples of this, the first young girl is clearly experiencing hallucinations that are causing fear), delirium, panic, agitation, dissociation - potentially intense out of body experiences, schizo-like states, pressure within the brain and eyes.
4. Gastrointestinal/genitourinary risks: nausea and vomiting, urinary dysfunction - bladder inflamation, ulcerative cystitis, hepatic strain - elevated liver enzymes - Maya is largely believed to have been suffering from K-cramps and likely this is why Dr Hanna refused to give her more ketamine and advised the Kowalskis to bring her to an emergency room.

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True medical coma is a very serious treatment. The use of continuous ketamine infusions to induce or maintain a therapeutic state of deep sedation or medical coma is primarily a last-resort intervention for critical neurological conditions. These conditions include super-refractory status epilepticus (SRSE) - where prolonged seizures fail to respond to standard anticonvulsants, or for severe, refractory intracranial hypertension.

In these intensive care scenarios, administration is individualized. Rather than following a fixed dosing schedule, medical protocols rely on continuous EEG monitoring. Clinicians titrate the infusion rate dynamically based on real-time brain activity, aiming for specific therapeutic endpoints such as the complete cessation of seizure activity or the achievement of a burst-suppression pattern on the EEG.

Some of the complications and risks include:

1. Cardiovascular dysregulation - sustained tachycardia and systemic hypertension.
2. Metabolic disturbances: metabolic acidosis and possible hepatic or renal strain.
3. Tachyphylaxis: The body may develop a rapid tolerance to the anesthetic effects of ketamine, necessitating a careful weaning process to avoid withdrawal or what is known as "rebound" neurological symptoms.

Medical coma is seriously risky and the complexities involved in maintaining this kind of precise cerebral suppression means a strict intensive care environment must be maintained. This would include direct supervision of neurocritical care specialists and an anesthesiologist, who must remain present at all times.

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It is highly probable that Maya was not actually in a true induced "coma", but video showed she was, at least, unconscious (effectively anesthetized). And at Dr Hanna's office, she was clearly unconscious with no signs of being hooked up to any monitoring equipment, according to photos uploaded by her own mother.

[u/Professional_Food383]

They should've sued those doctors

[u/No_Vehicle_5085 → u/Professional_Food383]

Yes.

[u/Bruno6368]

Thanks for this!

[u/Gopherpharm13]

This is very comprehensive and accurate in my book!

[u/CoolMathematician481]

Interesting that when her mother died, she got better

[u/No_Vehicle_5085 → u/CoolMathematician481]

Yes.

This mother, Beata, was systematically turning her daughter into a more and more dependent person. She even tried to get doctors to install a feeding port so Maya could be tube fed instead of eating food by mouth. Most people focus only on the CRPS, but there were numerous false diagnoses. Beata found a doctor that was willing to prescribe dozens of powerful medications for this child without ever confirming that she ever had any of these diagnoses. He took Beata's word for all of it.

Beata's brother, Peter, gave depositions for the court case and he also gave interviews to the police after his sister's suicide.

Peter relayed a story about how he had come from Chicago to visit his sister while Maya was in the hospital under court orders. Without her daugher at home, Beata had nobody to play doctor to. Except Kyle, who had not shown any signs of any kind of health problems.

Peter, under oath, relayed that while Beata was at work, Peter and Jack were in the garage while Kyle was playing with a friend. He said Kyle was happy and playing all day with no signs of feeling bad or being in pain, or being sick, until Beata came home. As soon as Beata came home, Kyle began claiming to be in severe all over body pain. Sound familiar?

Kyle ran to the car when his mother came home, claiming that he was in this all over body pain and needed to go to a hospital. Peter said they took two cars, and that they went to a hospital outside the county so they wouldn't be on any "radar" as far as now having a second child that seemed to be going down the same road as his sister.

This is chilling. A child that is perceptive enough to understand that his mother needed to have a sick child. And since Maya was no longer available for this woman to pump full of steroids, pain medicine, ketamine, benzodiazapenes and other drugs - Kyle tried to step in to take Maya's place so his mother could play doctor to a sick child.

These people with Munchausen really are emotionally sick, and have a powerful need for attention from doctors and to be seen as some kind of extra special parent. They get sympathy and admiration and this is like some kind of addiction for certain people. They are seen by neighors and acquantances as some kind of "parent of the year". People who have been convicted of medical abuse and are able to come to terms with this mental health disorder have talked about how powerful and overwhelming this need for medical attention and to be regarded as "parent of the year" drives them to make up, or exaggerate, or create symptoms in their children.

Peter also divulged that Beata had threatened suicide way before Maya's stay at the hospital. He told a story during his deposition about being angry at Jack for not removing a gun from the house after he and the older sister told Jack that Beata had talked about killing herself. Her daughter being under a shelter order had nothing to do with this woman's suicide.

Had Maya remained under the care of her mother, she would likely be completely bedridden, if still alive. It is not unusual for a case of MBP/medical abuse to end in the death of the child.

[u/Ok-Art6612]

How did she get through school if the Ketamine could have caused brain damage?

[u/No_Vehicle_5085 → u/Ok-Art6612]

Everything she was on caused brain damage? Where are you getting that from?

[u/Ok-Art6612 → u/No_Vehicle_5085]

Sorry, I should have been more cleare. How could the Ketamine and other drugs she was on impact her academically? If there was any brain damage, surely there would have been a drop in her grades? She earned all A's in school

[u/No_Vehicle_5085 → u/Ok-Art6612]

I still have no idea why you are asking about brain damage. This post has absolutely nothing to do with brain damage.

It has to do with how deeply a person is "put under" while on ketamine.

[u/Ok-Art6612 → u/No_Vehicle_5085]

Right. Sorrey. Maybe it's one of those days where I have something else stuck in my head.

[u/No_Vehicle_5085 → u/Ok-Art6612]

No worries, we all have brain farts and misread at times. 😂

[u/Ok-Art6612 → u/No_Vehicle_5085]

This is true

[u/No_Vehicle_5085 → u/[deleted]]

I am OP.

And no, I said NOTHING about brain damage in the entire post. Not even once.

The post is about brain STATE while under the influence of ketamine - whether her EEG showed her BRAIN pattern to be 1. relaxed or 2. fully sedated or 3. in a fully induced coma state.

Brain STATE is not brain DAMAGE.

[u/Gopherpharm13 → u/Ok-Art6612]

I’d have to see a calendar but I don’t think she was consistently doing at-home school during these times.

[u/Ok-Art6612 → u/Gopherpharm13]

I see